Provider Demographics
NPI:1295013365
Name:LARRABEE, NICKI J (FNP)
Entity Type:Individual
Prefix:
First Name:NICKI
Middle Name:J
Last Name:LARRABEE
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 500
Mailing Address - Street 2:
Mailing Address - City:PATTEN
Mailing Address - State:ME
Mailing Address - Zip Code:04765-0500
Mailing Address - Country:US
Mailing Address - Phone:207-528-2285
Mailing Address - Fax:207-528-2880
Practice Address - Street 1:1300 CRYSTAL RD
Practice Address - Street 2:
Practice Address - City:ISLAND FALLS
Practice Address - State:ME
Practice Address - Zip Code:04747-4369
Practice Address - Country:US
Practice Address - Phone:207-528-2285
Practice Address - Fax:207-528-2595
Is Sole Proprietor?:No
Enumeration Date:2011-07-23
Last Update Date:2013-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECNP111032363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MECNP111032OtherLICENSE
ME203814OtherGROUP NHIC PTAN